<!DOCTYPE html>
<html lang="zh-CN">

<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>健康打卡</title>
</head>

<body>
    <center>
        <h1>健康调查问卷</h1>
    </center>
    <form action="#" method="post" name="健康打卡">
        <fieldset>
            <legend>个人基本信息</legend>
            <label for="name">姓名：</label>
            <input type="text" name="name" id="name" value="<-请输入真实名字->">

            <label for="sex">性别：
                <label for="male">男</label>
                <input type="radio" name="sex" id="male" checked>
                <label for="female">女</label>
                <input type="radio" name="sex" id="female">
            </label>
            <br><br>
            <label for="institute">院校：
                <select name="institute" id="institute">
                    <optgroup label="信息学院">
                        <option value="Jike">计算机技术与科学专业</option>
                        <option value="ruangon" selected>软件工程专业</option>
                        <option value="wugong">物联网工程专业</option>
                    </optgroup>
                    <optgroup label="外国语学院">
                        <option value="English">英语专业</option>
                        <option value="Freach">法语专业</option>
                        <option value="German">德语专业</option>
                    </optgroup>
                </select>
            </label>
        </fieldset>
        <br><br>
        <fieldset>
            <legend>健康状况</legend>
            <label for="Temperature">体温:
                <input type="text" name="Temperature" id="Temp" value="例如：36.6">
            </label>
            <br>
            <label for="health">状况：
                <input type="checkbox" name="" id="health[]">正常
                <input type="checkbox" name="" id="health[]">发热
                <input type="checkbox" name="" id="health[]">咳嗽
                <input type="checkbox" name="" id="health[]">乏力
                <input type="checkbox" name="" id="health[]">嗜睡
            </label>
        </fieldset>
        <br><br>
        <fieldset>
            <legend>现处位置</legend>
            <label for="location">地理位置
            <select name="location" id="location">
                <optgroup label="江西省">
                <optgroup label="抚州市">
                    <option value="nc">南城</option>
                    <option value="lc">临川</option>
                    <option value="dx">东乡</option>
                </optgroup>
                <optgroup label="九江市">
                    <option value="lx">濂溪区</option>
                </optgroup>

                <optgroup label="南昌">
                    <option value="ncs">南昌市</option>
                </optgroup>
                </optgroup>
            </select>
        </label>
        </fieldset>
        <br><br>
        <fieldset>
            <legend>附件</legend>
            <label for="file">抗疫事件
                <input type="file" name="file" id="file">
            </label>
        </fieldset>
        <br><br>
        <fieldset>
            <legend>其他情况</legend>
            <label for="other">留言<br>
                <textarea name="other" id="other"></textarea>
            </label>
        </fieldset>
        <input type="submit" value="提交">
        <input type="reset" value="重置">
        <input type="image" src="https://ss0.bdstatic.com/70cFvHSh_Q1YnxGkpoWK1HF6hhy/it/u=2821023195,2474318419&fm=26&gp=0.jpg" alt="提交" width="100" height="50">
    </form>
</body>

</html>